We acknowledge that this article was inspired by research psychiatrist
E. Fuller Torrey, MD, and his book
Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and
Its Future.1
According to the dictionary, a witchdoctor is “a person in some
societies who attempts to cure sickness and to exercise evil spirits by
the use of magic.”
2 Torrey says that most witchdoctors, unlike
psychotherapists, “treat a wide variety of physical as well as mental
and social problems” (p. 9). In addition he says:

Therapists in
almost all cultures are closely allied with religious functions. Some of
the most successful of the modern African witchdoctors are associated
with the Christian sects. In Latin America, the
curanderos
utilize Catholicism and in Bali the
balians
utilize Hinduism in their therapeutic techniques. Often the therapists
[witchdoctors] and the religious leaders are one and the same person, as
are the Buddhist monks in Thailand and the
hodjas in
Turkey (pp. 8-9).

We are opposed to both witchdoctors and psychotherapists for different
reasons, but Torrey does provide a convincing case for why both appear
to be successful, which applies to all counseling.

In Chapter 1 of his book Torrey confronts psychotherapeutic
“imperialism” where psychotherapy is regarded as scientific and
witchdoctoring as prescientific. In a section titled “Magic or Science”
(p. 1),Torrey says:

One reason non-Western therapists and their techniques have been
­ignored is that they are automatically relegated to the realm of “mere
magic and superstition”.… This is to distinguish them from therapists in
our culture, who are thought to employ techniques based on modern
science.

The truth is not even close; it is a quantum jump away. The techniques
used by Western [psychotherapists] are, with few exceptions, on exactly
the same scientific plane as the techniques used by witchdoctors. If one
is magic, then so is the other. If one is prescientific, then so is the
other (p. 11).

A point Torrey restates later is that the techniques used in
witchdoctoring and psychotherapy “are on exactly the same scientific—or
prescientific—plane” (p. 79).

In Chapter 6, “Techniques of Therapy,” Torrey convincingly proves the
similarity of techniques of psychotherapists and witchdoctors. Torrey
says that techniques are supposed to be the trump card of
psychotherapists over the witchdoctors. He summarizes

This trump card is the techniques used in psychotherapy, techniques that
are thought to be sophisticated and scientific in Western cultures, and
to be primitive and magical elsewhere in the world.

In the psychotherapy game, however, there turns out to be no trump card.
Techniques of therapy used everywhere in the world are surprisingly
similar. Cultures, as will be shown, favor certain types of therapies
and techniques because they are more compatible with the customs or
values of the culture, but the differences are more quantitative than
qualitative (p. 78).

In Part II, “Psychotherapists in Action,” Torrey gives a clear picture
of how the various witchdoctors function as psychotherapists and how
they are similar to psychotherapists in how they practice their
techniques, even though varied throughout the world. We do not need to
revisit and rewrite much of what Torrey has done but merely to recommend
that those who are interested in the details of the comparisons of
techniques and the similarity of practices between witchdoctors and
psychotherapists read Torrey’s book.

Four Basic
Common Elements

One reason for writing about the subject of witchdoctors and
psychotherapists is to reveal that the fourbasic common elements used by psychotherapists and witchdoctors
worldwide are not exclusive. Torrey says:

Therapists all over the world utilize the same four components of
psychotherapy—[1] a shared worldview between therapist and client, [2]
personal qualities of the therapist, [3] expectations and emotional
arousal, and [4] an emerging sense of mastery in the client (p. 78).

Torrey rightfully puts techniques where they belong, i.e., in a needed
but negligible position compared to the four components. He says;

Furthermore, a
study of techniques used in therapy strongly suggests that it is not the
techniques themselves that are important, but rather the fact that the
techniques enhance the four basic components of psychotherapy…. It is
not that the techniques have
no
therapeutic value in and of themselves, but rather that their value is
negligible compared with the four basic components (pp. 78-79, italics
his).

[1] A Shared World View:
“Communication is [psychotherapy’s] essence. And real communication
presupposes not only a shared language but a shared worldview as well”
(p. 17). “The naming process is one of the most important components of
all forms of psychotherapy. It is also one of the most commonly
overlooked components” (p. 18).

[2] Personal Qualities:
“There is a general consensus that some psychotherapists have
personality characteristics which are therapeutic, while others do not
have such personality characteristics and are therefore less successful
as therapists” (p. 35). “Some of these ­re­searchers have claimed that
certain personal qualities of the therapist—accurate empathy,
nonpossessive warmth, and genuineness—are of crucial importance in
producing effective psychotherapy” (p. 42).

[3] Client Expectations:
“Along with a shared worldview and the personal qualities of the
therapist, client expectations are a powerful and important part of the
therapeutic process” (p. 54). “Since the therapeutic relationship is an
interaction between two individuals, the personal qualities of the
therapist and expectations of the client reverberate back and forth,
producing what is commonly referred to as the “fit” between therapist
and client” (p. 58).

[4]
Learning and Mastery:

The sense of mastery in a client is inextricably bound up with the other
components of psychotherapy. The naming process [shared world view]
contributes to the client’s confidence that somebody knows what is
wrong. The sense of mastery goes beyond that, however, equipping the
client with knowledge about what to do for the future and how to
overcome life’s adversities. Similarly, the client’s expectations and
emotional arousal contribute significantly to his or her feelings of
mastery and control (p. 70).

Torrey gives numerous examples of how the four components of
psychotherapy are the major contributors to efficacy (success) in both
psychotherapy and witchdoctoring. To clarify and dramatize the case for
the impact of cultural differences, Torrey says:

A [psychotherapist] who tells an illiterate African that his phobia is
related to a fear of failure and a witchdoctor who tells an American
tourist that his phobia is related to possession by an ancestral spirit
will be met by equally blank stares. And as therapists they will be
equally irrelevant and ineffective (p. 20).

The
naming
of the mental disorders needing therapy is so discrepant between the
American psychotherapist and the witchdoctor as to prevent even a
conversation to begin. The
cultural
differences are so great that therapy could not commence. This
dramatizes how the four components postulated by Torrey work togetherand are effective and most productive for successful therapy, but
only for those who have been acculturated to psychotherapy or
witchdoctoring.

While techniques are an essential ingredient in the help given and
received, they represent a subordinate role to the four components.
Since Torrey’s book was published much more research has been conducted
regarding factors outside of techniques that lead to successful outcomes
for both psychotherapists and witchdoctors.
We now turn our attention to those factors that reveal success rates for
both psychotherapists and witchdoctors.

Research Outcomes

Equal
Outcomes Phenomenon

There are about 500 different approaches in the field of psychotherapy.
Generally when psychotherapies have been tested and compared, it has
been found that, with certain exceptions, the research findings add up
to the claim that
all psychotherapies work and all seem to work equally well no matter how
contrary they are to one another.
This result is known in the research literature as the “equal
outcomes phenomenon.”3

Psychiatrist Jerome Frank says that from the therapists’ view, “little
glory derives from showing that the particular method one has mastered
with so much effort may be indistinguishable from other methods in its
effects.”4
The fact that there are about 500 different, often-conflicting
psychotherapeutic approaches and thousands of not-often-compatible
techniques with various incompatible underlying psychological theories
must raise a huge question mark over
why, on average, they
all seem to work equally well.
The exception to this conclusion is the fact that there are certain
types of psychological therapies, such as regressive therapy, that
produce up to forty percent detrimental effects.

This equal-outcomes finding, for which we provide research support
elsewhere,5
is not believed by those with individual therapeutic approaches, such as
cognitive behavioral therapy, the ­effectiveness of which has been
seriously questioned.6
However, the fact of the matter is that no one has been able to
demonstrate scientifically that there is a best approach when it comes
to psychotherapy.
If research established that one of the almost 500 approaches to
psychotherapy were ­declared the winner, there would be only one
psychotherapeutic approach agreed to by all. For every research report
that declares one of the approaches to be the best there will be other
research reports that will discredit that conclusion and claim equal
outcomes.

After reading Torrey’s book we conclude that there are probably as many
witchdoctoring approaches throughout the world as psychotherapies. And,
while conducting research on the variety of these approaches would
probably take a lifetime, we conclude that they would have equal
outcomes, not only based upon the four components cited by Torrey, but
also based on the research that we will cite shortly.

Common
Factors

The equal outcomes phenomenon (all psychotherapies work and all seem to
work equally well) naturally raises the question of what factors are
common to all therapies.
What are some common factors that would, on average, give most therapies
and therapists (i.e., psychotherapists and witchdoctors) positive
results?
Psychotherapy consists of a client, a psychotherapist, and a
methodology, which is centered in conversation, whereas the witchdoctor
methodologies, as seen in Torrey’s book, generally involve more than
just conversation. In most witchdoctor contexts the clients believe that
unseen spiritual entities are involved in the process. However, the
client, psychotherapist/witchdoctor, and methodology are the three
obvious factors to investigate to find what might be common to all
therapeutic success. Of these three, and far more important than the
other two, is the person being treated, because the client
determines the usefulness of the other two factors.

Client

There are various research guesses about exactly how much depends upon
the client in the process of change. However,
there is no question that the client is the most important and essential
element in change, as will be seen shortly.

Rapport

Henri F. Ellenberger gives a detailed history of the background and
emergence of psychotherapy in his monumental book
The Discovery of the Unconscious: The History and Evolution of Dynamic
Psychiatry.
He says, “Whatever the psychotherapeutic procedure, it showed the same
common basic feature: the presence and utilization of the rapport.”7
If a psychotherapist/witchdoctor is to best assist the client,
rapport is both a necessary ingredient and a common factor in all
psychotherapy/witchdoctoring.
Through rapport a bonding occurs between the psychotherapist/witchdoctor
and the client.

The current research stresses the great importance of rapport for
success in psychotherapy and calls it the
“therapeutic alliance.”
This term and its significance in successful psychotherapy is repeatedly
seen in the literature.A
Psychology Today
article says:

Researchers who
compare the success rates of various schools find that by and large,
techniques and methods don’t matter. What does matter is the powerful
bond between therapist and patient. The strength of this “therapeutic
alliance” seems to spell the difference between successful therapy and a
washout.8

Dr. Bruce Wampold reveals through his meticulous research that the
characteristics of the client and the psychotherapist and their
relationship (therapeutic alliance) had a far greater impact than the
treatment approaches. Wampold’s research further demonstrates that there
are
no differences in outcomes
when bona-fide treatments (i.e., those that have not demonstrated
detrimental effects that would disqualify them) are compared.9

The
Harvard Mental Health Letter
refers to the therapeutic alliance and says that it is “the working
relationship between patient and therapist that is probably the most
important influence on the outcome of therapy.”10

Psychotherapy Networker
says: “The therapeutic alliance—the ability to engage a client in
therapy, to forge and maintain a strong, personal connection with her,
convince her that the two of you are on a common path—remains the single
most important element of all therapy.”11

Regardless of the approach, psychotherapy or witchdoctoring, the two
most important factors for success are the personal qualities and
circumstances of the one who comes for help and the rapport that exists
between the psychotherapist/witchdoctor and client, which is a judgment
the client makes.

Is
Psychotherapy/Witchdoctoring a Placebo?

We next reveal the extent of the power of the placebo in the success of
psychotherapy and witchdoctoring. Dr. Arthur Shapiro, clinical professor
of psychiatry at Mount Sinai School of Medicine, suggests that the power
of psychotherapy may be the effect of a placebo. The placebo effect
takes place when one has faith in a pill, a person, a process or
procedure, and it is this faith that brings about the healing. The pill,
person, process, or procedure may all be fake, but the result is real.
Shapiro says, “Just as bloodletting was perhaps the massive placebo
technique of the past, so psychoanalysis—and its dozens of psychotherapy
offshoots—is the most used placebo of our time.”12

If psychotherapy and witchdoctoring indeed operate as placebos, the
approach one uses does not matter.
The client will interpret what he is receiving as helping him whether it
does or not. His thinking will then influence the result.

A number of studies support the idea that mental, emotional, and even
physical change may occur simply because of expectations. Simply
expecting to improve will often set the stage for improvement. In fact,
the authors of a book on the placebo effect say, “It may be that
interventions differ in effectiveness because they differentially elicit
expectancy of benefit.”13
Dr. David Shapiro calls this the
“expectancy arousal hypothesis,” which is that “treatments differ in
effectiveness only to the extent that they arouse in clients differing
degrees of expectation of benefit”14
(bold added).
The greater the expectation, the greater the possibility of
effectiveness.

If one out of three individuals finds relief through the use of a
medical placebo, what percent of the individuals who see a
psychotherapist receive similar relief through a type of mental placebo?
A group of researchers at Wesleyan University compared the benefits of
psychotherapy with those of placebo treatments. The placebo treatments
were activities (such as discussion of current events, group play
reading, and listening to records) that attempted to help individuals
without the use of psychotherapeutic techniques. The researchers
concluded that “after about 500 outcome studies have been reviewed—we
are still not aware of a single convincing demonstration that the
benefits of psychotherapy exceed those of placebos for real patients.”15

Dr. Arthur Shapiro criticized his professional colleagues at the annual
meeting of the American Psychopathological Association for ignoring
placebo effects and therefore skewing the results of their research.16
He believes that if placebo effects were considered “there would be no
difference between psychotherapy and placebo.”17

The above research on the placebo effects obviously applies to
witchdoctoring. Torrey has given us pictures of how witchdoctors
practice throughout the world and gives us a glimpse of “expectations”
in the client and how they, being one of the four components of success,
are played out in witchdoctoring.

Ingredients for Success

John C. Norcross and Marvin R. Goldfield, in their academic text of
psychotherapy research and results, estimate that the client and the
rapport (therapeutic alliance) if established by the psychotherapist
would average about 70 percent of the success with
client factors being the greater of the two.18
However, think about it. Who determines whether the
rapport or therapeutic alliance
is effective? Who believes whether the therapist can be trusted? Who
decides whether the client/psychotherapist relationship is a warm,
empathic, sympathetic one? Answer:
the client does.
The psychotherapist may try to establish rapport through various means,
but the client is the one who responds or rejects, and thus the
estimated figure of 70 percent of any success really has to do with the
clients and how they view the relationship. One therapeutic alliance
(rapport) researcher says: “When you’re a therapist, you think you know
the most important things about your client and therapy; it’s the
client’s perceptions about how things are going that have the greatest
predictive value of the outcome of therapy.”19

After surveying clients who had recently been in psychotherapy, the
authors of the study concluded:

The most powerful
alliance-building behaviors turn out to be basic human courtesies and
fundamental relationship skills, which have nothing to do with
therapists’ techniques or diagnostic abilities. Greeting clients with a
smile, making eye contact, sitting still without fidgeting, identifying
and reflecting back feelings, making encouraging and positive comments,
truthfully sharing negative information, normalizing feelings and
experiences, and remembering details from previous sessions turned out
to be extremely important factors.20

Allen Frances, MD, reports on “consistent research findings that should
make a world of difference to therapists and to the people they treat.”
He says: “The major focus of effective therapy—to establish a healing
relationship and to inspire hope…. A good relationship is much more
important in promoting good outcome than the specific psychotherapy
techniques that are used.”21

This evidence is seen repeatedly in the research: that the clients’
perceptions of the psychotherapist “have the greatest predictive value
of the outcome in therapy” and the personal qualities of the
psychotherapist that are rapport building will encourage the client to
­receive whatever methodology is ­offered. Nevertheless, the
effectiveness of the psychotherapy still depends on the client receiving
it. Here again, while there is no research specifically on
witchdoctoring throughout the world, nevertheless, the client who comes
to a witchdoctor is influenced by the “four common elements” as
described extensively by Torrey, plus the research we are currently
quoting.

In addition to the 70 percent for the client and psychotherapist,
Norcross and Goldfield give 15 percent for the placebo effect as an
important factor for success. Remember, the placebo effect is a sham
treatment, in this case a psychological treatment that through belief on
the part of the client is received and responded to as a valid
treatment.22
In other words, no matter what treatment the therapist uses, if the
client responds positively to it, there is a therapeutic effect.
Notice that it does not matter what the treatment is; the receiving and
responding are on the part of the client.
Thus the resulting estimate should add up to about 85 percent for how
the client receives and responds to the therapy.

If one combines the interpersonal qualities of the psychotherapists, the
external factors involved outside the office, and the placebo effect,
this may account for much of what may be working to bring about any
success in psychotherapy and witchdoctoring.
In other words, the particular approach is not what leads to change, nor
the theories, training, or techniques:
it is the interpersonal environment plus the placebo effect. And all of
these, of course, pale in comparison to the individual’s desire to
change and his willingness to take the responsibility to do so. Because
of the “four common elements” referred to by Torrey and the current
research quoted, the 85 percent figure for the client who goes to a
witchdoctor would apply.

Finally, in addition to the 15 percent for the placebo effect, Norcross
and Goldfield give only 15 percent to the methodology. However, we
remind the reader of the equal outcomes phenomenon, which means that no
specific methodology or specific technique is necessarily the best and
thus required for success.
This could apply to witchdoctors, with no specific witchdoctoring and no
specific technique necessarily being the best and thus required for
success within their common spiritual context. Excluding those
psychotherapies that are known to be detrimental, whatever technique or
theory is selected has a considerably smaller effect than the
therapist/client factors.

In reviewing a book entitled
Psychotherapy Research: Methodological and
Efficacy Issues,
published by the American Psychiatric Association, the
Brain/Mind
Bulletin
says, “Research often fails to demonstrate an unequivocal advantage from
psychotherapy.” The following is an interesting example from the book:
“An experiment at the All-India Institute of Mental Health in Bangalore
found that Western-trained psychiatrists and native healers had a
comparable recovery rate. The most notable difference was that the
so-called ‘witchdoctors’ released their patients sooner.”23

We repeat, Torrey says that “psychotherapy
does
work and that its effectiveness is primarily due to four basic
components—a shared worldview, personal qualities of the therapist,
client expectations, and an emerging sense of mastery” (p. 198, italics
his). All of these factors are at play in all effective human
relationships.
None of these factors require training, techniques, degrees, or
licensing.
All of these factors may be at work whether a person is in treatment or
not. The same factors which lead to improvement inside formal treatment
also work outside of formal treatment, or alongside it, which adds more
questionability to the whole psychotherapeutic/witchdoctoring mind game.

In summary, the client is the keystone to successful treatment. This
fact is the reason for psychotherapies being about equally effective
(equal outcomes phenomenon), with the exception of those that produce as
much as a 40 percent harm rate mentioned above.
In other words, the clients who are motivated to succeed, who engage in
the rapport with the psychotherapist (therapeutic alliance), and who
believe that they are receiving a valid treatment (placebo effect) will
most likely succeed, regardless of the approach and regardless of the
therapist being an amateur or professional.
Therefore, clients who meet these conditions and are given entirely
different types and even contradictory therapies tend to have similar
success rates. These ­research results of psychotherapy complement and
augment the research results found in Torrey’s book on the success of
witchdoctors.

Regardless of the research results, one should not be afraid to minister
­biblically, because the Bible offers what no psychotherapy or
witchdoctoring can offer and that is salvation, spiritual growth, and an
eternity with Jesus. Ministering biblically would go far beyond the
equal outcomes level of change!
There is not even one therapeutic theory, technique, or methodology that
can trump the biblical care of souls and what God has to offer those
suffering from the issues of life.

Endnotes

1E. Fuller Torrey.
Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and
Its Future,
revised ed. of
The Mind Game.
Northvale, NJ: Jason Aronson Inc., 1986.. Hereafter page references to
this book will be in parentheses.